Gynaecology - Colposcopy procedures and treatment

The aim of this leaflet is to help you understand more about the procedures, and prepare you for when you attend the colposcopy clinic.

Punch biopsy to the cervix

What is a biopsy?

During your colposcopy, the colposcopist may take a small sample of the tissue from the neck of the womb, this is sent to the laboratory. If there are any abnormal changes identified then you may require one of the treatments detailed below.

What should I expect after a biopsy?

• The biopsy procedure may cause mild cramping, brief pain, and some slight bleeding afterwards
• Avoid sexual intercourse, tampons or swimming for 1 week
• There is a small risk of infection, which can be further reduced by adhering to the above recommendations

You can take simple painkillers like paracetamol. If you should experience an offensive discharge, or feel unwell, then please contact your colposcopy unit or your GP for advice. On the rare occasion you may need to take antibiotics.

Treatment to the cervix

Why do I need treatment?

You will have been advised that you need treatment following your recent smear/colposcopy identifying abnormal cells on the neck of the womb (cervix). This does not mean you have cancer, however, it does mean that the cells are showing some changes that may turn into cancer in the future if left untreated. This condition is known as cervical intraepithelial neoplasia (CIN) which is graded 1, 2 or 3. Your own result will be discussed with you when you attend clinic.

The aim of treatment is to remove the abnormal cells with minimal damage to the healthy tissue or to help prevent bleeding after sexual intercourse or problems with excessive discharge. The treatment is usually very effective, but a minority of women may require a repeat procedure.

What types of treatment are available?

Cryotherapy to the cervix

Cryotherapy involves freezing the cervix (neck of the womb). It is commonly used for skin conditions such as warts, but also to treat bleeding caused by a cervical ectopy. The procedure itself is simple and takes less than five minutes to perform.

The area to be treated is first identified by using a speculum (like when you have a smear test) once visible the probe is then connected to a gas cylinder containing carbon dioxide, which is used to freeze the area. You will hear a hissing sound when the treatment starts.

It is usual for treatment to be repeated more than once to completely treat the affected area. The procedure is not painful, but can be uncomfortable. Occasionally, you may feel a stinging sensation.

Cold coagulation/diathermy ablation

This is a method of destroying abnormal cells on the cervix with the use of a heated probe (suitable for minor abnormalities).

The procedure is usually performed under local anaesthetic and only lasts approximately 30 seconds. The discomfort is usually like period cramps and quickly subsides.

This is a speedy non-invasive procedure, which can be carried out as an outpatient. On rare occasions deeper levels of the cervix are involved and a further treatment may be needed. The alternative would be a loop excision.

Loop excision

This technique uses an electrically heated fine wire loop to remove the abnormal tissue from the neck of the womb.

A lead with a sticky pad is attached to a machine. This forms a circuit which allows the loop to work. The tissue that is removed is sent to the laboratory for examination and to check that all abnormal cells have been removed.

Approximately 80%-90% of women requiring treatment will be suitable for this procedure, which usually takes less than 15 minutes. If you have a large area of abnormal tissue or are very anxious, you may have the procedure under a general anaesthetic at a later date.

Laser Ablation

This just means the laser burns away the abnormal cells.

A laser beam is a very strong, hot beam of light which burns away the abnormal area. This is currently only carried out under general anaesthetic (whilst you are asleep).

Knife cone biopsy

This requires admission as it is performed under general anaesthetic (whilst you are asleep). The abnormal tissue on the inside and outside of the neck of the womb is surgically removed. The tissue is sent to the laboratory to check that all the abnormal cells have been removed.

Frequently asked questions

Which treatment will I need?

When you come to the clinic, your colposcopist will discuss the treatment options and agree the best treatment for you. If you have an important event or have arranged a holiday abroad within two weeks of your treatment, please discuss this with your practitioner as you may experience some bleeding after your treatment and might be restricted in your activities (i.e. swimming) for a while.

What happens on the day of my treatment?

It is not advisable to perform treatments if you are having your period. If this is the case please re-arrange your appointment.

Your treatment should take approximately 15 minutes, however you should allow up to an hour. You may bring a friend, partner or relative who can stay with you throughout the procedure, but please be aware that if you bring children, we cannot provide childcare whilst you are having your colposcopy, so you will need to bring a responsible adult to care for your children in the waiting room.

You will be asked to undress from the waist down, but you can keep your skirt on if you wish. Most treatments are carried out as an outpatient in the colposcopy clinic under local anaesthetic (whilst you are awake). If you have a coil this may have to be removed prior to treatment.

Treatment is not advisable during pregnancy, please ensure that you use suitable contraception once you receive your colposcopy invitation.

The treatments are relatively painless as local anaesthetic will be used, but you may have period type pains during the procedure. Some women may experience tingling in the legs, or light headaches, this is due to the position in which you are lying.

If the type of treatment you need requires local anaesthetic, you might feel your legs getting a bit shaky after the injection, but that should settle soon after. Following the treatment you will be asked to rest for a short while and offered a drink. You will be given time to ask questions.

Are there any risks with the procedure?

As with any procedure, there is a small chance of getting an infection. If at any time soon after, you experience heavy bleeding, which is unlikely to be a period, or the discharge becomes smelly you should seek some advice/treatment from your colposcopy clinic or GP as you may have an infection.

There is a small risk that cone/loop excision might increase the risk of pre-term labour or late miscarriage, especially if you fall pregnant soon after treatment, please discuss this with your colposcopist.

In some rare cases the neck of the womb may become narrow due to scarring, (this is called cervical stenosis). This usually happens if you had more than one treatment and it may be necessary either to widen the cervical canal in a short outpatient procedure or for future smears to be carried out in the colposcopy clinic.

On return home

You can expect to feel absolutely fine afterwards. However, some women do feel vulnerable and weepy for a short while.

Some dos and don’ts:

• You must rest and avoid standing for long periods of time as this could delay recovery
• You may experience period type pain. It is advisable to take simple painkillers, like those you normally take for period pain
• Shower if possible, or if bathing, don’t use any perfumed products or soak for too long, as this can delay the healing process
• You should refrain from sexual intercourse for 4 weeks, after which you should use contraception, and avoid becoming pregnant until you have had a negative smear result
• Unless told differently your next menstrual period should be due as normal, but can be slightly heavier
• It is normal to have some blood loss/discharge for a few weeks after treatment. Use sanitary towels to reduce the risk of infection. Tampons should not be used for 4 weeks
• If you have any heavy fresh bleeding and your period is not due, contact your colposcopy clinic or GP for advice. An out of hours number can be found at the end of this leaflet
• Avoid strenuous exercise, like aerobics/horse riding for at least a week. Avoid swimming for a least 4 weeks or until any bleeding/discharge has stopped

When will you get your results?

We will write to you and your GP in approximately 2 to 4 weeks time with the results.

What about follow-up?

It is likely that you will require a HPV Primary test of cure sample in six months time at your GP surgery. You will be advised accordingly on the day of your treatment/following results.

Who to contact for further advice

If after your procedure you have any specific worries, or require further information do not hesitate to contact the colposcopy clinic on the following numbers:

Fairfield General Hospital - 0161 778 2349
The Royal Oldham Hospital - 0161 627 8076
Salford Royal Hospital Colposcopy Secretary - 0161 206 4433
Salford Royal Hospital Nurse Colposcopist - 0161 206 5224

Out of Hours Contacts

Royal Oldham Hospital - Please contact the Gynaecology Assessment Unit on 0161 627 8855.
Salford Royal Hospital - Please contact the Surgical Triage Unit on 0161 206 4004 or 0161 206 4943.